NPIMap

Organization Active NPI

PHR of Maryland, Inc.

  • Home Health Agency
  • Lanham, MD
National Provider Identifier
1700900248
Registry record updated Dec 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HH7120 Issued in MD
Legal business name
PHR OF MARYLAND, INC.
Practice address
4429 Forbes Blvd
Lanham, MD 20706-4328
Phone
(301) 552-8325
Fax
(301) 552-2734
NPI assigned
Mar 19, 2007
Last updated
Dec 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian Clemens
Title
Director of Finance
Phone
(703) 752-8710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HH7120 MD Primary

Addresses

Primary practice location

4429 Forbes Blvd
Lanham, MD 20706-4328

Mailing address

7619 Little River Tpke
Suite 600
Annandale, VA 22003-2625
Phone (703) 752-8700

Other identifiers 1

IdentifierTypeStateIssuer
402109600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030611000046 MD Part A Provider - Home Health Agency 8628988821 Practice locations: Lanham, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700900248. Details of each certification follow.

Home health agency certification: CCN 217120A

Legal name
PHR OF MARYLAND, INC.
Organization structure
CorporationProprietary
Incorporated
May 2, 2003 in VA
Enrollment address
4429 Forbes Blvd
Lanham, MD 20706-4328

Care Compare: Home health agency

Medicare Care Compare
Listed as
PHR of Maryland, Inc.CCN 217120
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Sep 20, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address. The facility is not in the current Medicare enrollment files, which can mean its Medicare enrollment has ended (or, for VA and military hospitals, that it does not enroll).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0678718PHR of Maryland, Inc4429 Forbes Blvd, Lanham, MD 20706Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory

Locations

4429 Forbes Blvd
Lanham, MD 20706
Phone (301) 552-8325

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oluremi Jolaoso Individual W-2 Managing EmployeeAdministrator Dec 1, 2017
Professional Healthcare Resources, Inc. Organization, Annandale, VA Operational/Managerial Control May 2, 2003
De Cesare GST Non-Grantor Gift Trust Organization, Annandale, VA Created for acquisition 5% Or Greater Indirect Ownership Interest Feb 29, 2008 52.4%
Professional Healthcare Management, Inc Organization, Annandale, VA Management services company Operational/Managerial Control Jan 1, 2008
Ronald Decesare Individual 5% Or Greater Indirect Ownership Interest Feb 29, 2008 45%
PHR Holdings, Inc. Organization, Annandale, VA Created for acquisition, Holding company 5% Or Greater Direct Ownership Interest May 2, 2003 100%
Pilar Z Godoy Individual Corporate OfficerBoard Treasurer May 2, 2003
Corporate DirectorBoard Treasurer May 2, 2003
OtherBoard Treasurer Feb 29, 2008
Eileen Decesare Individual Corporate OfficerPresident and Board Chair May 2, 2003
Corporate DirectorPresident and Board Chair May 2, 2003
Operational/Managerial Control Jan 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 14

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229299200000",
    "number": "1700900248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7619 LITTLE RIVER TPKE",
            "address_2": "SUITE 600",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032625",
            "telephone_number": "703-752-8700",
            "fax_number": "703-752-8719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4429 FORBES BLVD",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064328",
            "telephone_number": "301-552-8325",
            "fax_number": "301-552-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHR OF MARYLAND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2008-12-15",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "703-752-8710"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MD",
            "license": "HH7120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402109600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

Verify at the official NPI Registry.